Introduction
In vitro fertilisation (IVF) has revolutionised reproductive medicine, offering hope to countless couples struggling with infertility. Central to the success of IVF are the incubators used to culture embryos with two primary types currently commonly used: benchtop incubators and time-lapse incubators. This blog post will discuss these two types of incubators, focusing on their impact on IVF outcomes and laboratory workflow efficiencies, exploring the promising potential for integrating embryo development videos with modern AI-assisted embryo assessment software, as well their impact on patient experience
IVF Outcomes
Benchtop Incubators
Benchtop incubators have been the standard in IVF laboratories for many years since taking over from the previously dominating large ‘box’ incubators due to their superior performance. They provide controlled environment for embryo culture by maintaining stable temperature, CO2, and often also humidity levels. They also contain small chambers with only a limited number of dishes in each chamber, thus reducing the need for frequent access to each chamber in the course of busy laboratory operations. However, embryos must still be periodically removed from the incubator for assessment, which can expose them to fluctuations in environmental conditions such as temperature and gas environment.
Studies have shown that while benchtop incubators are effective, the removal of embryos for assessment can negatively impact their development. Some studies comparing benchtop incubators with time-lapse incubators suggest no significant differences in fertilisation and cleavage rates between the two, but embryos in benchtop incubators having lower blastocyst quality.
Time-Lapse Incubators
Time-lapse incubators, such as Geri®, offer continuous monitoring of embryo development without the need to remove them from the controlled environment. Time-lapse technology allows for the capture of images at regular intervals, creating a time-lapse video of embryo development.
Several studies suggest that time-lapse incubators can improve IVF outcomes especially in the first embryo transfers in the cycle, leading to faster achievement of pregnancy. Reduced handling of embryos is believed to contribute to that effect, however, findings vary between studies and study designs.
Laboratory Workflow Efficiencies
Benchtop Incubators
Benchtop incubators require manual handling of embryos for their assessment, which can be time-consuming and labour-intensive when embryologists remove embryos from the incubator according to a strictly defined schedule, evaluate their development under a microscope and return them to the incubator. This process not only disrupts the controlled culture environment but also introduces the risk of handling accident.
Despite these challenges, benchtop incubators are relatively simple to operate and maintain. They are also less expensive than time-lapse incubators, making them a viable option for many IVF laboratories.
Time-Lapse Incubators
One undisputed advantage acknowledged by time-lapse incubator users is the improvement in workflows and operational efficiency, They streamline workflows in IVF laboratories by reducing the need for manual assessments, as the continuous monitoring system allows embryologists to make informed decisions without disturbing the embryos. They also facilitate embryo assessments at any time and at any location, which can lead to more efficient use of staff resources and scheduling.
Moreover, the ability to review time-lapse videos can enhance the accuracy of embryo assessments. Embryologists can observe developmental milestones and identify potential issues that may not be apparent during periodic assessments, which in turn can lead to better selection of embryos for transfer, ultimately improving IVF success rates
AI-Assisted Embryo Assessment
Integration with Benchtop Incubators
Integrating AI-assisted embryo assessment software with benchtop incubators is challenging due to the intermittent nature of embryo assessments, and can only be achieved by manual image capture and additional manual steps to submit such images for software assessment. Periodic assessments at fixed times also limit the amount of information available for the software.
While this approach is not as effective as continuous monitoring, it can still enhance the accuracy of embryo selection.
Integration with Time-Lapse Incubators
Time-lapse incubators are ideally suited for integration with AI-assisted embryo assessment software due to continuous stream of images providing a rich dataset for AI algorithms to analyse. This allows for more accurate predictions of embryo viability and potential for successful implantation.
AI algorithms can analyse various parameters such as cell division patterns and morphokinetic markers, as well as benefit from additional deep learning approach based on thousands and thousands of embryos with known outcomes used for training it to predict embryo developmental and implantation potential. Several studies have been published about the effectiveness of AI-assisted embryo assessment using time-lapse data, although their final clinical usefulness is yet to be determined. Nonetheless, again the undisputed advantages include faster and standardised embryos assessment, which can be of significant benefit to a busy IVF clinic.
Impact of Viewing Embryo Development Videos on IVF Patient Experience
Emotional Connection and Reassurance
One of the most significant impacts of providing patients with images or videos of their developing embryos is the emotional connection it fosters. Seeing the early stages of their potential future child can be a profoundly moving experience for many patients. This visual connection can provide reassurance and a sense of involvement in the IVF process, which can be empowering and comforting.
Some studies suggest that patients who viewed time-lapse videos of their embryos feel more connected to the process and experience a greater sense of control and reassurance. This emotional connection can be particularly important in a process that often feels clinical and detached.
Anxiety and Misinterpretation
However, the impact is not universally positive. Some patients may experience increased anxiety when viewing these videos, especially if they don’t fully understand what they are seeing. Without proper guidance and explanation from medical professionals, patients might misinterpret normal variations in embryo development as signs of problems.
Hence while many patients appreciate receiving videos of their embryos, the lack of professional support in interpreting these videos can lead to unnecessary distress, especially as patients often watch these videos at home without the immediate ability to ask questions or seek clarification, which can exacerbate their anxiety.
Enhanced Transparency and Trust
Providing patients with access to embryo development videos can also enhance transparency and trust between patients and their healthcare providers. When patients are able to see the development of their embryos, they may feel that the process is more transparent and that they are being kept informed every step of the way.
This transparency can help build trust and strengthen the patient-provider relationship.
Impact on Decision-Making
Access to embryo development videos can also impact patients’ decision-making processes. By seeing the development of their embryos, patients may feel more confident in the decisions they, their doctor or the clinic makes regarding embryo transfer and other aspects of their treatment.
Therefore patients who have access to time-lapse videos may be more likely to feel confident in the selection of embryos for transfer, which could potentially lead to higher pregnancy rates. This confidence can reduce the emotional burden of decision-making and contribute to a more positive IVF experience.
Conclusion
Both benchtop and time-lapse incubators have their advantages and limitations in the context of human IVF. Benchtop incubators are cost-effective and straightforward to use but require manual intervention that can disrupt controlled culture environment, impact embryo development and require carefully timed involvement of staff. Time-lapse incubators, on the other hand, offer continuous monitoring, often improved IVF outcomes and offer flexibility in workflows and improved laboratory efficiencies, but come at a higher cost.
The integration of AI-assisted embryo assessment software with time-lapse incubators represents a significant advancement in reproductive medicine. The continuous data provided by time-lapse incubators allows AI algorithms to make more accurate predictions, enhancing the embryo selection process and improving IVF success rates.
The ability to view images or videos of developing embryos can have a profound impact on patients’ experiences during an IVF cycle. While it can foster emotional connection, reassurance, and enhanced transparency, it can also lead to increased anxiety if not accompanied by proper professional support. Ensuring that patients receive adequate guidance and explanation when viewing these videos is crucial to maximizing the positive impacts and minimizing potential distress.
Ultimately, the choice between benchtop and time-lapse incubators will depend on the specific needs and resources of the IVF laboratory. However, the trend towards time-lapse technology and AI integration suggests a promising future for improving IVF outcomes and laboratory efficiencies.